Hematology Case 7
Presented By Dr Mohammad Moharram
Released on 05-09-2019Patient Data
70 Year Male
Clinical Data
Patient with history of ischemic heart disease (with 2 stents), diabetes mellitus .
Submitted for renal transplant abroad 3 years ago. (on immunosuppresive therapy)
He reported low platelet count in many occasions before.
admitted as a case of uorosepsis; fever, Rigors , generalized body aches, dysurea, uncontrolled urination.
Blood pressure: 105/55. - Heart rate:78
Related Laboratory Results
WBC : 17.9x10^3/uL
HGB: 9.9 g/dL
MCV: 83 fL
MCH: 25 pg
MCHC: 30%
Platelet: 18x10^3/uL
Urine Analysis: Glucose +++ , Protein++, RBC over100, Leukocytes over 100
Glucose: 18.2 mmol/L (R.R.: 2.5-6.4)
BUN: 19.4 mmol/L (R.R.: 2.5-6.4)
Creatinine: 273 mmol/L (R.R.: 55-113)
Na: 126 mmol/L (R.R.: 136-144)
INR: 1.6
APTT: 47 sec (R.R.: 26-41)
K, LDH and UA: Normal
Blood film is requested to exclude pseudothrombocytopnea
Case Picture(s) / Photo(s)
Comment / Findings
Leukocytosis with absolute neutrophilia and absolute eosinophilia.
Neutrophils show shift to left
Most of neutrophils has basophilic cytoplasmic inclusion bodies ; (Dohle like bodies). They are also seen in the cytoplasm of monocytes and eosinophils
Severe thrombocytopnea. No platelet aggregates. Giant platelets are commonly seen.
Estimated platelet count by blood film: 20x10^3/uL
Final Diagnosis
Picture of septic neutrophilia however May-Hegglin anomaly is suspected.
MYH9 gene mutation work up is recommended.